Strangulated congenital diaphragmatic hernia with partial gastric necrosis: a rare cause of abdominal pain in pregnancy

Rajasingam, Daghni; Kakarla, A.; Jones, Annette; Ash, Alok

doi:10.1111/j.1742-1241.2005.00763.x

Cited by 9 publications

(8 citation statements)

References 6 publications

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“…Chest radiographs, ultrasonography (USG) [ 25 ], and magnetic resonance imaging (MRI) have reliable diagnostic significance for evaluating a suspected BH regardless of pregnancy status [ 21 , 32 , 33 , 38 , 39 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Maternal Bochdalek Hernia during Pregnancy: A Systematic Review of Case Reports

et al. 2021

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Background: Since the first report of a diaphragmatic hernia from Ambroise Paré’s necropsy in 1610, the Bochdalek hernia (BH) of the congenital diaphragmatic hernia (CDH) has been the most common types with high morbidity and mortality in the neonatal period. Due to the nature of the disease, CDH associated with pregnancy is too infrequent to warrant reporting in the literature. Mortality of obstruction or strangulation is mostly due to failure to diagnose symptoms early. Data sources and study selection: A systematic literature search of maternal BH during pregnancy was conducted using the electronic databases (PubMed and EMBASE) from January 1941 to December 2020. Because of the rarity of the disease, this review included all primary studies, including case reports or case series that reported at least one case of maternal BH in pregnant. Searches, paper selection, and data extraction were conducted in duplicate. The analysis was performed narratively regardless of the control groups’ presence due to their rarity. Results: The search retrieved 3450 papers, 94 of which were deemed eligible and led to a total of 43 cases. Results of treatment showed 16 cases in delayed delivery after hernia surgery, 10 cases in simultaneous delivery with hernia surgery, 3 cases in non-surgical treatment, and 14 cases in hernia surgery after delivery. Of 16 cases with delayed delivery after hernia surgery, 13 (81%) cases had emergency surgery and three (19%) cases had surgery after expectant management. Meanwhile, 10 cases underwent simultaneous delivery with hernia surgery, 6 cases (60%) had emergent surgery, and 4 cases (40%) had delayed hernia surgery after expectant management. 3 cases underwent non-surgical treatment. In this review, the maternal death rate and fetal/neonatal loss rate from maternal BH was 5% (2/43) and 16% (7/43), respectively. The preterm birth rate has been reported in 35% (15/43) of maternal BH, resulting from maternal deaths in 13% (2/15) of cases and 6 fetal loss in 40% (6/15) of cases; 44% (19/43) of cases demonstrated signs of bowel obstruction, ischemia, or perforation of strangulated viscera in the operative field, resulting from maternal deaths in 11% (2/19) of cases and fetal-neonatal loss in 21% (4/19) of cases. Conclusion: Early diagnosis and surgical intervention are imperative, as a gangrenous or non-viable bowel resection significantly increases mortality. Therefore, multidisciplinary care should be required in maternal BH during pregnancies that undergo surgically repair, and individualized care allow for optimal results for the mother and fetus.

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Section: Discussionmentioning

confidence: 99%

Maternal Bochdalek Hernia during Pregnancy: A Systematic Review of Case Reports

et al. 2021

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“…[ 4 ] The prime factor is the rise in intraabdominal pressure and may be due to several causes, including persistent coughing/chronic obstructive airway disease (COPD),[ 37 38 ] vigorous physical activity, sneezing, chronic constipation,[ 44 ] retching, large meals, diving, fits of laughter, pregnancy, and childbirth. [ 9 10 11 12 52 54 55 56 57 58 59 ]…”

Section: Precipitating Factorsmentioning

confidence: 99%

“…Overall, 5.3% of the adult patients with BH in our review were pregnant. [ 9 10 11 12 54 55 56 57 58 59 60 61 62 ] Pregnancy has been found to be the most significant predisposing factor and is seen in 34% of cases where at least one precipitating factor is noted. [ 4 ] The management of these patients and the timing of surgical repair with regard to the stage of pregnancy is debatable.…”

Section: Association With Pregnancymentioning

confidence: 99%

Laparoscopic repair of bochdalek diaphragmatic hernia in adults

Machado

2016

North Am J Med Sci

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Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its presentation and management, based on the present evidence in the literature. A literature search was performed on PubMed, Google Scholar, and EMBASE for articles in English on BH in adults. All case reports and series from the period after 1955 till January 2015 were included. A total of 180 articles comprising 368 cases were studied. The mean age of these patients was 51 years (range 15-90 years) with a male preponderance of 57% (211/368). Significantly, 6.5% of patients were above 70 years, with 3.5% of these being above 80 years. The majority of the hernias were on the left side (63%), with right-sided hernias and bilateral occurring in 27% and 10%, respectively. Precipitating factors were noted in 24%, with 5.3% of them being pregnant. Congenital anomalies were seen in 11%. The presenting symptoms included abdominal (62%), respiratory (40%), obstructive (vomiting/abdominal distension; 36%), strangulation (26%); 14% of them were asymptomatic (detected incidentally). In the 184 patients who underwent surgical intervention, the surgical approach involved laparotomy in 74 (40.27%), thoracotomy in 50 (27.7%), combined thoracoabdominal approach in 27 (14.6%), laparoscopy in 23 (12.5%), and thoracoscopic repair in 9 (4.89%). An overall recurrence rate of 1.6% was noted. Among these patients who underwent laparoscopic repair, 82% underwent elective procedure; 66% underwent primary repair, with 61% requiring interposition of mesh or reenforcement with or without primary repair. The overall mortality was 2.7%. Therefore, BH should form one of the differential diagnoses in patients who present with simultaneous abdominal and chest symptoms. Minimal access surgery offers a good alternative with short hospital stay and is associated with minimum morbidity and mortality.

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“…Generally, the preferred technique for diagnosis is plain radiography, even during pregnancy. Surgery is often recommended during the second trimester, when fetal organogenesis is complete and the fetus is relatively stable 1–3 . Pregnant women with an asymptomatic DH in their third trimester should be closely monitored and treated conservatively until the fetus reaches maturity.…”

Section: Introductionmentioning

confidence: 99%

“…Surgery is often recommended during the second trimester, when fetal organogenesis is complete and the fetus is relatively stable. [1][2][3] Pregnant women with an asymptomatic DH in their third trimester should be closely monitored and treated conservatively until the fetus reaches maturity. Then an elective cesarean section may be performed.…”

Section: Introductionmentioning

confidence: 99%

Diaphragmatic hernia during pregnancy: A case report with a review of the literature from the past 50 years

Chen¹,

Hou²,

Zhu

et al. 2011

J of Obstet and Gynaecol

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Diaphragmatic hernia is a rare complication during pregnancy. Only 30 reports have been published on this subject in English between 1959 and 2009. Due to misdiagnoses and management delays, diaphragmatic hernia usually presents itself as a life-threatening emergency. Here, we present a case report of a patient with a traumatic diaphragmatic hernia who became acutely symptomatic during pregnancy. The diaphragmatic hernia was managed successfully, and we describe the presentation, management and outcome of this case. We also present a review of all of the reported cases of diaphragmatic hernias complicating pregnancy that have been published in English during the past 50 years.

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Strangulated congenital diaphragmatic hernia with partial gastric necrosis: a rare cause of abdominal pain in pregnancy

Cited by 9 publications

References 6 publications

Maternal Bochdalek Hernia during Pregnancy: A Systematic Review of Case Reports

Maternal Bochdalek Hernia during Pregnancy: A Systematic Review of Case Reports

Laparoscopic repair of bochdalek diaphragmatic hernia in adults

Diaphragmatic hernia during pregnancy: A case report with a review of the literature from the past 50 years

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